MEGA REVIEW DAY 1 Flashcards
Normal end feels: 3
Hard: bone to bone stiff sensation that is painless Ex. Elbow EXT
Soft: yielding compression Ex. Elbow/knee flex
Firm: toward end ROM= elastic resistance Ex. ER shoulder (lig or capsular end feel restricting more mvmt)
PAIN and end feel? == Empty bc wont get full ROM from them!
EmPty end feel think…
Pain
Abnormal End Feels:
Springy–> meniscus tear
Boggy–> edema
Mushy–>
Empty–> Pain
Scapular Winging types: 2
most common?
- Open book palsy/Medial winging–> Serratus Ant (Long thoracic N.)
- Sliding door palsy/Lateral winging–> Trapz (CN XI)
activate SA–> push up, SA pushup
Scapular UPWARD rot and DOWNWARD rot
UPward: Upper/Lower trpz, Serratus Ant
DOWNward: Pec minor, rhomboids, levator scap
When will you SEE medial winging d/t Serratus ant (long thoracic nerve) lesion?
Lifting arm above 90degs shoulder FLEX
THINK… bc Serratus punches are given @ 90degs shoulder flex
Heart sounds
APT-M 2245
Mitral site BEST for auscultation if S3 (vent gallop) present
Heart sounds
APT-M 2245
Mitral site BEST for auscultation if S3 (vent gallop) present
Erbs point auscultation
5th point–> 3rd ICS
More on heart sounds:
S1/2== normal
S3 (CHF)/4(HTN, MI, vent hypertrophy)== abnormal (will hear these @ apex, mitral valve)
RPE (6-20 scale) and SHVEM
Start @ 13!
S= 13 (Somewhat hard)
H= 15 (Hard)
V= 17 (Very hard)
E= 19 (Extremely hard)
M= 20 (Max exertion)
REVERSE SHVEM, start @ 13
S= 13 (Somewhat hard)
H= 11 (Light just opp hard)
V= 9 (Very light)
E= 7.5 (Extremely light)
M= 6 (No exertion)
RPE (6-20 scale) and SHVEM
Start @ 13!
S= 13 (Somewhat hard)
H= 15 (Hard)
V= 17 (Very hard)
E= 19 (Extremely hard)
M= 20 (Max exertion)
REVERSE SHVEM, start @ 13
S= 13 (Somewhat hard)
H= 11 (Light just opp hard)
V= 9 (Very light)
E= 7.5 (Extremely light)
M= 6 (No exertion)
RPE rx for DM
11-13 for DM, progress to 12-17
EASY way to breakdown Dermatomes
C1-C4= head/neck
C5-T1= arm
C6-C8= fingers
Sensory Examination
Superficial Sensation
Exteroreceptors–> Receive stimuli from EXTERNAL environment via skin and subQ tissue Ex. Pain, temp, lt touch
Sensory Examination
Deep Sensation
Proprioreceptors–> Receive stim from mm’s, tendons, fascia
Ex. Pos. sense/awareness of jts @ rest, kinesthesia, vibration
Sensory Examination
Cortical Sensation
Combo of BOTH Superf/Deep
Ex. Stereognosis (ID obj), 2-pt discrim, barognosis (pressure), graphestesia (drawing letters), localization, recognition of texture, double simultaneous stimulation
DCML mnemonic
Poor Val Got GBS Twice
Proprio, Vibration, Graphestesia, Barognosis, Stereognosis, 2-pt discrim
Lateral Spinothalamic (STT)
Ant STT
Lateral= Pain + Temp
LPT
Anterior= crude touch
Glasgow Coma Scale
All w/ mnemonics
See pic
Glasgow Coma Scale Totals
<8= coma
3-8= severely abnormal
9-12= moderately abnormal
13-14= mildly abnormal
15= mild TBI
Glasgow Coma Scale
EMV
4, 6, 5
- Eyes (4 letters, so 4)
- Verbal (the V in front is 5 roman numeral)
- Motor (remaining 6)
Glasgow Coma Scale
HOW to remember Ea section
Eyes Opening (1-4)– “Waking husband up Sunday morning”
- 4: Spontaneous (he spontaneously wakes up on his own)
- 3: To speech (you call him to wake up)
- 2: To pain (you pinch him to wake up)
- 1: No response
Motor (1-6)– “OLD BEN”
- 6: Follows motor commands (Obeys commands)
- 5: Localizes
- 4: w/Drawals (flexor w/drawal)
- 3: Abnormal flexion (Bending)
- 2: Extensor resp
- 1: No resp
Verbal (1-5)– Think baby or child growing up (meaning lvs going UP)
- 1: No response
- 2: Incomprehensible sounds (making sounds)
- 3: Inappropriate words (saying words)
- 4: Confused conversation (having conversation)
- 5: Oriented
Normal Blood Gases
PaCo2: 35-45
pH: 7.35-7.45
HCO3-: 22-26
Remember ROME
Resp (CO2)–> OPP to pH direction; Metabolic (HCO3-)–> EQUAL to pH direction
pH + Normal Blood Gases Questions
STEPS!
-
Look @ pH
Normal 7.35-7.45: Answer is Compensated -
Look @ PaCO2
Normal 35-45: Answer is Metabolic -
Look @ HCO3-
Normal 22-26: Answer is Respiratory -
None of three are normal
Answer is Partially Compensated
Stages of Lymph03dema
(0-3)
ALL FIRST
see pics
Stage 0 Lymph03dema
Latency
- NO edema (Heaviness only)
- NEGATIVE stemmer
- Tissue/skin appear normal
Stage 1 Lymph03dema
Reversible
- Edema present (PITTING)
- Edema INCs w/ standing/activity
- NEGATIVE stemmer
Stage 2 Lymph03dema
Spontaneously IRreversible
- Edema present; soft/pitting EARLY then progresses to brawny, NONpitting
- POSITIVE stemmer (maybe neg. early on)
- Tissue appears fibrosclerotic; proliferation of adipose tissue
Stage 3 Lymph03dema
Lymphostatic Elephantiasis (think elephant feet)
- Edema present; SEVERE brawny, NONpitting
- POSITIVE stemmer
- SKIN CHANGES!!!!–> Papillomas, deep skinfold, warty protrusions, hyperkeratosis, mycotic infxs
Stages of LIPedema
2 lips== B/L, P is for proximal, LEs only, NEVER feet
See pics
Lymph03dema vs LIPedema
NOTE w/ Lymphedema:
- U/L OR B/L asymmetric
- cellulitis common
- NO pain
- distal edema present in foot
- Stemmer (+), Stages II/III
Cranial Nerves
How do you remember where they ARE?
CE (1,2), MI (3,4), PONS (5,6,7,8), MEDU (9, 10, 11, 12)
CN 7 and 9 differentiation
7 (facial)= ANT
9 (trigeminal)= POST (P is backwards 9)
Taste= facial
Sensory= Trigeminal
Common gait abnorms: 4
ELABORATE
- Step LENGTH deviations (FLOP= tight hip flexors OPP leg step leg length
- Trunk bending deviations (Magnet Theory in STANCE only!!!)
- LLD deviations (think David in his High Heels)
- Inad mm control deviations
IMPORTANT Gait definitions
Gait cycle: Heel strike to next I/L heel strike
Stride: one full gait cycle (heel strike to NEXT same foot heel strike)
Step: One foot to the other foot
Ex. shorter step length on R. side
A: R. glute max contracture
- Tight EXTs or stuck in EXT, SO will have shorter step length bc cant go into hip flexion bc EXTs are tight!!!
2 Tests for High Ankle Sprain
Think TIBIOfibular ligament!!!
- Syndesmotic squeeze (Hopkin’s) Test– bc gapping @ the syndesmosis distally
- Kleigers (ER/DF) Test –crank on it– NEUTRAL foot and have them short sit w/ foot hanging off edge–Same MOI as high ankle sprain
Ankle special tests differentiation:
Talar tilt w/ ankle in neutral DF== CFL, can also tilt into EVERSION for deltoid lig (medial ligs)
Ant Drawer w/ ankle neutral DF== Anterior TALOfibular lig (depending on where you stabilize/mob== ligs tested (ATFL vs deltoid ligs)
Compression of shafts of tib/fib @ mid calf== Syndesmotic squeeze== TIBIOfibular ligament
Squeezing calf w/ ankle neutral DF== Thompson== Achilles rupture— + will be absent PF
Appendicitis tests
RLQ pain==AC==Appendicitis/Crohn’s
- Obturator sign (ER)– passive stretch into IR, supine
- Psoas sign (hip flexor)– passive stretch into hip EXT, S/L w/ affected side UP
- McBurneys pt– bw ASIS/umbillicus–RLQ
- Rovsing’s Sign– palpate LLQ== pain in RLQ
MORE!–> Blumbergs (rebound tender), Inch+Pinch on R (right on appendix site), Single hop test (RLQ pain), Markel sign (heel drop sign)
3 Diff Murphy’s Signs
- Acute Cholecystitis–gallbladder- RUQ– deep breath and pull up into rib one
- Murphy’s Punch for Kidneys–kidneys- pyelonephritis
- Lunate dislocation (hand)– knuckles lining up one (middle knuckle lines up= (+)– remember middle knuckle usually protrudes out more
Referred Pain Patterns
ALL!!!!
RUQ: Good Luck Hot Pack (Gallbladder, Liver, Head of pancreas, Peptic ulcers
RLQ: AC (Appendix, Crohn’s)
LUQ: Dont Banana Split (Diaphragm, Body/tail of pancreas, SpLeen (Kehrs sign) SLR and pain in L. shoulder)
LLQ: DUI (Diverticulitis, Ulcerative colitis, IBS)
Heart== L shoulder/arm
Functional Independence Measure (FIM)
Assist lvls–Patient participitation
7 (BEST)–> 1 (WORST)
Outcome measure assesses lvl of functional status of person based on lvl of assistance required
7: COMPLETE IND (timely, safely)
6: MOD IND (use of AD)
5: Supervision (cueing, setup, coaxing)
4: MIN A (Pt participation= 75% or more)
3: MOD A (Pt participation= 50-74%)
2: MAX A (Pt participation= 25-49%)
1: DEPENDENT (Pt participation= LESS than 25%)
Straight Leg Raise Test: 4
SLR (Basic), SLR 2, SLR 3, SLR 4
SLR (Basic)–Sciatic + Tibial
- Hip flex/add
- Knee ext
- Ankle DF
SLR 2 (TED-Tibial Eversion DF)–Tibial
- Hip flex
- Knee ext
- Ankle DF
- Foot eversion
- Toe ext
SLR 3 (SID- Sural Inversion DF)–Sural
- Hip flex
- Knee ext
- Ankle DF
- Foot inversion
SLR 4 (PIP–Peroneal Inversion PF)–Common Peroneal
- Hip flex + IR
- Knee ext
- Ankle PF
- Foot inversion
LBP Conditions Table
See Table:
Breakdown:
1. Spondys vs
2. Disc Herniation vs
3. Spinal stenosis (narrowing of vert canal)
LBP Cond’s
Spondy’s
Spondylosis–think DEGEN, >50yo
Spondylolysis–think Pars fx, scotty dog, 15-20yo
Spondylolisthesis–think slippage (usually anterior), 20yo (can progress to degen w/ age)– TEST= Stork Test
Aggravating factors: Ext, Standing mostly; bending to lift objs (spondylolysis/listhesis)
Relieving factors: Sitting (all 3); bending (spondylosis)
SLR Test: NEGATIVE all 3
Imaging: X-ray (all 3)
LBP Cond’s
Disc Herniation (think posterolat nucleus protrusion)
Age: 30-50
Loc: Back, leg (U/L)
Aggravating: Sitting (flex bias), Bending, Ascending stairs
Relieving: Extension, Standing (Ext bias), Descending stairs
SLR Test: POSITIVE
Imaging: MRI/CT–bulging disc
LBP Cond’s
Spinal Stenosis
Test: Van Gelderan
Think narrowing vert canal
“The shopping cart leaners”
Age: >60
Loc: back, legs (B/L)
Aggravating: Ext, Standing (Ext bias)
Relieving: Sitting, Bending
SLR: POSITIVE
Imaging: CT, MRI and X-ray
HypERthyroid- “Hyper David who never gains wt”
HypOthyroid- “Lazy husband laying on couch all day w/ comforter”
ALL FIRST
See table:
HypER– sped up
HypO– slowed down
HypERthyroid
Dis’s== Exopthalmos (bulging eyes), Grave’s
- INCd T3/4== LOW TSH (bc trying to lower T3/4)
- INCd HR, DEC BP (bc NOT sedentary)
- High BMR (sped up)
- Heat INtolerance (bc always moving/sweating)
- INCd GLU absorb (bc moving always)== Lower blood glucose
- Restless, insomnia (obv)
- Diarrhea (bc sped up)
- Silky hair, moist palm (bc always sweating)
- Wt LOSS + Incd appetite (always eating, never gain wt)
- INCd perspiration
- HYPERreflex (bc HYPERthryoid)
HypOthyroid
Dis’s== Myxedema, Hashimoto’s
- DECd T3/4, HIGH TSH bc trying to INC T3/4
- DECd HR, HIGH BP (bc sedentary so makes sense)
- Low BMR (slowed down)
- COLD intolerance (lazy guy laying on couch w/ comforter, hes cold)
- DECd GLU absorb (sedentary), higher blood glucose
- Sleepy, tired, Prox mm weakness (bc laying on shoulder & prox mm’s)
- Constipation (bc slowed down)
- Brittle nails, dry skin and hair (bc slowed down)
- Wt GAIN, decd appetite (not eating, but still gain wt)
- Decd perspiration (not moving)
- Prolooonged DTRs (bc HypOthyroid)
Types of HAs
ALL FIRST
U/L= Cervicogenic, Cluster, Migraines
B/L= Tension
Types of HA:
Cervicogenic
U/L
- pain in occipital region– spreads to frontal area
- Sx’s aggravated by mvmt or sustained postures
Types of HA:
Cluster
the “stabbing pain” one
U/L, M>F
- pain around one eye
- sharp, stabbing, throbbing
- Autonomic sx’s: sweating face, lacrimation
Types of HA:
Migraines
“photophobia” one
U/L, F>M
- pain on one side of face
- pulsating quality
- Aggravation w/ routine phys act and assocd w/ nausea, vom, photophobi
Types of HA:
Tension
ONLY B/L one
B/L, band across forehead one
- Tight or pressure across forehead like a band
- Mm tightness/tender in facial and CS mm’s
- Assocd w/ stress, anxiety, depress– aka STUFF THAT CAUSES TENSION!!!
Aquatic Therapy
All first
Think Heart is HAPPY
see table
Active Insuff vs Passive Insuff
Active= SAME motion as mm
Passive= OPPOSITE motion as mm
One (psoas) and Two (Rec Fem) Joint Hip Flexor
Psoas– 1 jt hip flexor–crosses 1 jt
Rec Fem– 2 jt hip flexor– crosses 2 jts: Hip AND Knee
Thomas Test Interpretations: Sign vs Structures Affected
- EXTd knee==> Quads, rec fem
- Flexed hip==> Psoas
- Abd’d hip==> TFL/ITB
- Lateral rotation of tibia==> Biceps fem (bc biceps fem, lateral HS== ER tibia + knee flex)
If you see Thomas Test question + hip FLEXOR stretch– go w/ Thomas Test – think HIP FLEXORS
Ely’s Test— think QUADS!!!!
AV Blocks Summary
Block, ECG Interp, PT Response:
- First Degree– INC PR interval (looong PR)– Continue exercise, benign
- Second Degree Type I (Weckenbach)– Progressive inc in PR interval, then DROP! (long, looonger, drop)– Monitor and cont @ LOWER intensity
- Second Degree Type II (Mobitz II)– Normal PR interval until SUDDEN drop (norm, norm, drop)– STOP exercise, NO 911
- Third Degree–No relationship (NO comm. bw Ps & Qs)–Stop IMMEDIATELY and refer, 911!!!
PICO question
What is it? Example?
P: Population/Problem (Ex. LBP)
I: Intervention/Dx/Prognosis (Ex. traction)
C: Comparison bw Tx groups (Ex. nothing)
O: Outcome measures used to measure variables (Ex. Outcome, Dep variable)
How do you remember Independent variable?
I for I
Ind variable is the Intervention!!!
Isolated Precautions
ALL FIRST
See table
Isolated Precautions: KEY STUFF
Iso Type: Contact Precautions
MRSA, VISA, VRE, C-Diff, Hep-A/B
PPE: Gloves & Gown
Hand wash BEFORE and AFTER
Isolated Precautions: KEY STUFF
Droplet Precautions
Mumps (Rubella), Strep, Meningitis, PNA, Influenza
PPE: Mask when w/in 3ft
Hand was UPON ENTERING and Leaving room
Isolated Precautions: KEY STUFF
Airborne Precautions
Measles, TB, Varicella, Herpes Zoster (dermatomal pattern rash)
PPE: N-95 mask, Gown and Gloves–discard mask upon LEAVING room
Hand was UPON ENTER and LEAVING
private room w/ NEGATIVE air flow
Heart sounds and CLOSING of valves
S1– assocd w/ closing of Tricuspid/Mitral valves– “S1TM”
S2– assocd w/ closing of Aortic/Pulmonic valves– “S2AP”, SAP and 2 looks like S
S3– early DIASTOLE– CHF– heard @ apex (bottom of heart–mitral valve
S4– MI/HTN/Vent hypertrophy– heard @ apex (bottom of heart–mitral valve
WOUNDS!
Arterial– LAT malleolus– pain w/ elevation
Venous (VenMO)– MEDIAL malleoulus– elevation DECs pain (gravity assists w/ venous return)
MS and Unthoff’s
Neuro sx’s worsen w/ in the heat
AVOID HEAT
“Oof, its hot”
